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Published on: May 14, 2012
The use of bronchial challenge to diagnose asthma in preschool children
1Hadassah-Hebrew University, Hadassah University Hospital, Jerusalem 91120, Israel. sgodfrey@netvision.net.il
Insights
Diagnosing asthma in young children is crucial. A safe inhalation bronchial challenge test, using adenosine 5'-monophosphate (AMP), accurately detects bronchial hyperreactivity, aiding in correct asthma diagnosis.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
Background:
- Wheezing and respiratory symptoms are prevalent in preschool children.
- Accurate asthma diagnosis in this age group is challenging but essential.
Purpose of the Study:
- To describe an approach for diagnosing asthma in preschool children using an inhalation bronchial challenge.
- To highlight the safety, practicability, and specificity of this diagnostic method.
Main Methods:
- Inhalation bronchial challenge with increasing doses of adenosine 5 -monophosphate (AMP).
- Detection of wheezing below the normal response threshold indicates bronchial hyperreactivity.
- Initial methods included stethoscope auscultation, respiratory rate, and pulse oximetry.
- Advanced methods utilize acoustic recordings to quantify wheeze objectively.
Main Results:
- The inhalation bronchial challenge with AMP is safe and practical for preschool children.
- The test demonstrates specificity for asthma diagnosis.
- Acoustic analysis of breath sounds shows high correlation with clinical wheeze detection.
Conclusions:
- Inhalation bronchial challenge with AMP is a reliable method for diagnosing asthma in preschool children.
- Objective acoustic quantification of wheeze enhances diagnostic accuracy.
- Emerging automated equipment further facilitates this diagnostic approach.
Abstract:
Wheezing and respiratory symptoms are very common in preschool children, and the ability to diagnose asthma correctly is important. This review describes an approach to the diagnosis of asthma in preschool children by means of an inhalation bronchial challenge. The child is exposed to increasing doses of challenge agent until wheezing is detected at a dose below that at which normal subjects respond, thus indicating bronchial hyperreactivity. The technique was originally developed using simple stethoscope auscultation of the lungs together with recording of respiratory rate and oxygen saturation (by pulse oximetry). Extensive studies have confirmed the safety and practicability of the technique and the specificity for asthma when the challenge agent is adenosine 5'-monophosphate (AMP). Subsequently, acoustic recordings have been used to detect and analyse breath sounds and to quantify the wheeze; these show excellent correlation between the clinical detection of wheeze and the wheeze rate (duration of wheeze/duration of recording) during bronchial challenges in children. Equipment is now becoming available that can perform the acoustic quantification of wheeze automatically and facilitate bronchial challenges in young children.
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